Observation Deck: Simple Solutions for Complex Times

Who could dispute that today’s healthcare system is extremely complex? Just look at the IDNs in which you work. Spread out over tens or even hundreds of miles, they employ hundreds or thousands of people, encompass various centers of excellence, and house a wide array of medical technology and information systems. Providing consistent, high-quality care is no easy task.

Yet, despite the complexity, the answer to improving care is remarkably low-tech. At least that’s what we heard repeatedly while researching this month’s articles. That answer rests, simply, with people making the choice to listen to each other, to work together and to respect one another.

It’s what Baylor CEO Joel Allison calls the key to providing safe, quality and compassionate care. (See this month’s Executive Interview.) It’s what Tom Hughes, Greg Firestone, Bruce Clark and others talk about in this month’s article about physician preference items. And it’s the process George Hersch of Norton Healthcare describes in this month’s Model of the Future, which deals with that IDN’s technology assessment program.

Eric Louie, M.D., spoke about the same thing in his presentation on interventional medicine at the recent Consorta Annual Resource Management Conference in Chicago. To make his point, Louie pointed to something as old as medicine itself Ð turf wars. You know what he’s talking about: Woman patients with uterine fibroids. Gynecologist recommends one course of action, interventional radiologist recommends another. Both are convinced they’re right. Meanwhile, the woman’s well-being takes a back seat to the battle of the physicians.

Louie, who is vice president for Skokie, Ill.-based Sg2, spends his time helping providers move from a physician-focused approach to a patient-focused one, from what he calls Òunidirectional information transferÓ to a free flow of information, and from silos to multispecialty, collaborative care.

The transformation begins with the realization that hospitals and IDNs are more than bricks and mortar that house labs, exam rooms, ORs and offices full of very important people, says Louie. He believes hospitals should be information centers and gathering places for various types of expertise. Yes, physicians will continue to argue and compete with one another. But they must do so in the larger context of cooperation, keeping the patient’s welfare foremost in their minds. So what if that gynecologist loses his hysterectomy, or the cardiac surgeon her quadruple bypass? There are more than enough patients to go around for everyone, he says.

Louie envisions an environment in which consumers are free to choose Ð with input from a multispecialty team of physicians Ð the best course of treatment for them. It’s an environment in which care is delivered Òbased on evidence-based standards and care protocols instead of idiosyncratic experience and craftsmanship.Ó It’s an environment of patient-focused teamwork. Such a system calls for several things, he says:

Strong leadership.
New incentive systems.
Consensus on what constitutes good care.
An environment that emphasizes patient safety.
High-quality information systems.

The best leader is someone who can step outside the fray and keep everyone focused on the needs and desires of the patient, he says. That leader should be a physician, perhaps a diagnostician Ð in other words, someone who doesn’t have a vested interest in what course of treatment is ultimately settled on.

Incentive systems must be created that encourage doctors to adopt a patient-centered approach, says Louie. Today, doctors are typically rewarded for performing procedures. The problem with that is, those procedures are not always in the best interest of the patient. Incentive systems should reward physicians for participating in cross-functional teams, in which the emphasis is on what Louie calls Òlongitudinal care,Ó that is, care that follows a person long after he or she leaves the hospital. In such a system, clinical performance is rewarded, to be sure. But so is a doctor’s ability to work with others.

Clinicians must arrive at a consensus on what constitutes good care. It should rest on evidence-based standards, that is, evidence that caregivers can analyze, debate and, ultimately, agree upon. ÒIt’s all about guaranteeing safety and getting the best quality outcomes,Ó says Louie.

Patient safety has to come first. Systems must be put in place to prevent complications and mistakes. That can only occur in an environment in which mistakes are acknowledged and learned from. ÒIt means preventing bad things from happening, yet not hiding when bad things do happen,Ó says Louie. ÒIf we recognize mistakes and recognize ways to minimize them, we can avoid harm. We can create an accountable learning environment, so that when we make mistakes, we don’t get blamed for them; instead, we learn from them.Ó

Implicit in almost all these things is information. As Louie says, the hospital and IDN are becoming information centers, not warehouses for high-tech equipment and people in white coats. Information must flow freely in all directions Ð from caregiver to patient, patient to caregiver, and caregiver to caregiver. Such an environment can be created without sophisticated electronic medical records systems Ð but it ain’t easy.

Focus on the patient and all else will fall into place. Pretty simple, isn’t it?

Mark Thill About Mark Thill

Mark Thill is the Editor of The Journal of Healthcare Contracting and has been reporting on healthcare supply chain issues since 1985. He is a graduate of Dominican University in River Forest, Ill., and he received a master's degree in journalism from Northwestern University in Evanston, Ill.

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